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Scientific Articles

First paediatric live donor liver transplant in Sri Lanka with 1 year outcome : challenges for the future

Authors:

Rohan Siriwardana ,

Colombo North Centre for Liver Disease, University of Kelaniya, Sri Lanka., LK
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S Thilakarathne,

Colombo North Centre for Liver Disease, University of Kelaniya, Sri Lanka., LK
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M Fernando,

Colombo North Centre for Liver Disease, University of Kelaniya, Sri Lanka., LK
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M. B. Gunetilleke,

Colombo North Centre for Liver Disease, University of Kelaniya, Sri Lanka., LK
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A Weerasooriya,

Colombo North Centre for Liver Disease, University of Kelaniya, Sri Lanka., LK
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C Appuhamy

Colombo North Centre for Liver Disease, University of Kelaniya, Sri Lanka., LK
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Abstract

Introduction
Liver transplantation in the paediatric age group is demanding
due to smaller body proportions and physiology. This paper
describes the first successful paediatric liver transplant in Sri
Lanka along with its one-year outcome. Describing the
challenges faced during the process, we highlight the factors
that need to be considered for a sustainable programme in the
future.

Methodology
A 9-year-old girl who had progressive familial intra hepatic
cholestasis type 3 was referred to us with features of end stage
liver disease. She was identified as a suitable candidate for
liver transplantation. Her 38-year-old mother was selected as
the donor, who was evaluated for suitability of a left lateral
segment donation.

Results
The first paediatric liver transplantation was performed in
July 2020. The child's mother donated the left lateral segment
weighing 325g. During the postoperative period the child
developed outflow tract obstruction at the hepatic venous
anastomosis. This was managed with a percutaneously placed
stent. Six months after transplant, she developed an acute
rejection that required steroids. Treatment of rejection was
complicated with multiple liver abscesses caused by
Aspergillus. The infection was treated with systemic
antifungals and drainage. At one-year post transplant, the
recipient had recovered from the trauma of surgery and had
normal liver biochemistry, a patent hepatic venous stented
anastomosis and complete resolution of the abscesses. We
faced dual challenges in dealing with a live liver transplant
donor and a young child who was the recipient. Our success,
on this occasion, was underscored by the multidisciplinary
contribution from specialists scattered across the island
combined with state-public partnership.

Conclusion
To offer a sustainable live donor liver transplant service for
the future, many other aspects, beyond surgery itself, need to
be addressed.

How to Cite: Siriwardana R, Thilakarathne S, Fernando M, Gunetilleke MB, Weerasooriya A, Appuhamy C. First paediatric live donor liver transplant in Sri Lanka with 1 year outcome : challenges for the future. Sri Lanka Journal of Surgery. 2021;39(3):33–5.
Published on 30 Nov 2021.
Peer Reviewed

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